The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

HEALTH CARE RELATED PNEUMONIAE, TREATMENT MANAGEMENT WITH DISTAL PROTECTED SAMPLE UNDER FIBER OPTIC EXAM.

Philippe Goutorbe1, Guillaume Lacroix1, Bertrand Prunet1, Tiphaine Gaillard2, Olga Maurin1, Jerome Maslin2, Guillaume Delort1, Eric Meaudre1



Background: Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection. HCAP are microbiologically similar to hospital-acquired infections and thus these patients are at risk for multi-drug-resistant (MDR) pathogens. The recommendation of ATS to treat HCAP is to use broad spectrum and multiples antibiotics. This strategy is expensive and have individual and collective adverse effects on pathogens resistances.
We expressed the assumption that bronchoscopic distal protected micro-lavage with quantitative cultures may decrease ecological and economical cost of broad spectrum antibiotics.

Methods:
after approval of hospital local ethic's committee and informed consent of the patient we prospectively performed fiber-optic distal protected micro-lavage for HCAP at the emergency room. The fiber-optic exam was realised under non invasive ventilation (NIV). The initial empiric therapy was chosen by the physician. When bacteriological results was available the antibiotics were modified. Cost of our "invasive" strategy and cost of an empirical strategy (ATS guidelines for HCAP with risk factor of MDR: piperacilline tazobactam, ciprofloxacine and vancomycine) were compared.

Results:
During three months we prospectively checked 25 patients with HCAP, 21 have fiber-optic micro-lavage, 4 exams was contra-indicated because of haemostatics problems.
The patients was 69+-15,33 years old.
The average Fine's score was: 140+-34.
We have no adverse effect of the fibroscopy.
In 11 cases bacteriological results induced antibiotics changes with antibiotic's spectrum reduce.
In 10 cases empirical antibiotherapy was not adapted because no pathogen was found 6 cases or patient died before microbiology results.
The fiber-optic sampling costs 110,40 euro. Despite this price the invasive strategy permitted an economy of 253,49 euro per patient.

Conclusion:
Fiber-optic distal protected micro-lavage showed a good sensitivity and specificity in international literature. The quality of this exam allows change in treatment. In HCAP the probability of MDR pathogens is high, thus broad spectrum antibiotics should bee used. When bacteriological exam can qualify the infectious pathogen and his antibiotics sensitivity, the physician is able to reduce the cost of treatment. More-over ecological pressure of broad spectrum antibiotics can be reduced.
fiber-optic distal protected micro-lavage seems to be a safe and efficient strategy in managing HCAP.